Modern Approaches to the Diagnosis and treatment of Clostridioides difficile (C. difficile)-associated Disease in Adults (literature Review and Expert Council Resolution)
V. T. Ivashkin,
I. V. Maev,
D. N. Andreev,
O. V. Goloshchapov,
A. A. Derinov,
O. Yu. Zolnikova,
K. V. Ivashkin,
O. Yu. Kiseleva,
A. P. Kiryukhin,
O. S. Lyashenko,
E. A. Poluektova,
A. S. Tertychnyy,
A. S. Trukhmanov,
A. I. Ulyanin,
A. A. Sheptulin,
O. S. Shifrin https://doi.org/10.22416/1382-4376-2023-33-2-19-33
Abstract
Aim: to review the modern approaches to the diagnosis and treatment of C. difficile-associated disease in adults and present the resolution of the Expert Council held on March 25, 2023 in Moscow.
General provisions. C. difficile is the most important nosocomial pathogen which spores are also commonly found in the environment. Microbiota impairment, primarily due to the use of antibacterial drugs, is a key stage in the development of C. difficile-associated disease. A search for an infection should be carried out only in patients with diarrhea, and it is advisable to use at least 2 laboratory methods. The drug of choice for first-line treatment is vancomycin. If drug treatment is ineffective or the patient has recurrent clostridial infection, fecal microbiota transplantation should be considered. The probiotic strain Saccharomyces boulardii CNCM I-745 has a direct inhibitory effect on C. difficile toxin A, promotes normalization of the intestinal microbiota composition, and decreases the inflammatory reaction in colonic mucosa colonized with a toxigenic strain of C. difficile.
Conclusions. Addition of the probiotic strain Saccharomyces boulardii CNCM I-745 to antibacterial therapy promotes both primary and secondary prevention of C. difficile-associated disease.
Keywords
intestinal microbiota,
antibiotics,
diarrhea,
C. difficile,
pseudomembranous colitis,
video colonoscopy,
fecal transplantation,
probiotics,
Saccharomyces boulardii CNCM I-745
Supporting agencies: The Expert Council was held with the organizational support of the pharmaceutical company Biocodex.
About the Authors
V. T. Ivashkin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Vladimir T. Ivashkin — Dr. Sci. (Med.), RAS Academician, Prof., Departmental Head, Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, N.V. Chief of Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University).
119435, Moscow, Pogodinskaya str., 1, bld. 1
I. V. Maev
A.I. Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation
Russian Federation
Igor V. Maev — Dr. Sci. (Med.), RAS Academician, Prof., Departmental Head, Department of Propaedeutics of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry.
127473, Moscow, Delegatskaya str., 20, bld. 1
D. N. Andreev
A.I. Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation
Russian Federation
Dmitry N. Andreev — Cand. Sci. (Med.), Assoc. Prof., Department of Internal Medicine Propaedeutics and Gastroenterology, Yevdokimov Moscow State University of Medicine and Dentistry.
127473, Moscow, Delegatskaya str., 20, bld. 1
O. V. Goloshchapov
I.P. Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Oleg V. Goloshchapov — Cand. Sci. (Med.), Research Assistant, Department of anesthesiology and resuscitation, Pavlov University, St. Petersburg, Head of ICU No. 3, R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation.
197022, Saint Petersburg, L'va Tolstogo str., 6-8
A. A. Derinov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Aleksandr A. Derinov — Cand. Sci. (Med.), Associate Professor; Department of Surgery, Institute of Clinical Medicine, Sechenov First Moscow State Medical University.
119435, Moscow, Pogodinskaya str., 1, bld. 1
O. Yu. Zolnikova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Oksana Yu. Zolnikova — Dr. Sci. (Med.), Professor; Chair of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University); Chief External Gastroenterologist of the Central Federal District of the Russian Federation.
119435, Moscow, Pogodinskaya str., 1, bld. 1
K. V. Ivashkin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Konstantin V. Ivashkin — Cand. Sci. (Med.), Associate Professor; Chair of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University).
119435, Moscow, Pogodinskaya str., 1, bld. 1
O. Yu. Kiseleva
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Olga Yu. Kiseleva — Cand. Sci. (Med.); Head of the Department of Resuscitation and Intensive Care, Vasilenko Clinic of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University).
119435, Moscow, Pogodinskaya str., 1, bld. 1
A. P. Kiryukhin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Andrey P. Kiryukhin — Cand. Sci. (Med.); Endoscopist, Department of Diagnostic and Therapeutic Endoscopy, University Clinical Hospital No 2, Sechenov First Moscow State Medical University (Sechenov University).
119435, Moscow, Pogodinskaya str., 1, bld. 1
O. S. Lyashenko
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Olga S. Lyashenko — Gastroenterologist, Department of Gastroenterology, Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University).
119435, Moscow, Pogodinskaya str., 1, bld. 1
E. A. Poluektova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Elena A. Poluektova — Dr. Sci. (Med.), Prof., Chair of Internal Disease Propaedeutics, Gastroenterology and Hepatology; Gastroenterologist, Department of Chronic Intestinal and Pancreatic Diseases, Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University).
119435, Moscow, Pogodinskaya str., 1, bld. 1
A. S. Tertychnyy
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Aleksandr S. Tertychnyy — Dr. Sci. (Med.), Professor; Strukov Department of Anatomical Pathology, Sechenov First Moscow State Medical University (Sechenov University).
119048, Moscow, Trubetskaya str., 8, bld. 2
A. S. Trukhmanov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Alexander S. Trukhmanov — Dr. Sci. (Med.), Professor; Chair of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University).
119435, Moscow, Pogodinskaya str., 1, bld. 1
A. I. Ulyanin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Anatoly I. Ulyanin — Gastroenterologist, Department of Chronic Intestinal and Pancreatic Diseases, Vasilenko Clinic of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University).
119435, Moscow, Pogodinskaya str., 1, bld. 1
A. A. Sheptulin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Arkadiy A. Sheptulin — Dr. Sci. (Med.), Professor; Chair of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, First Moscow State Medical University (Sechenov University).
119435, Moscow, Pogodinskaya str., 1, bld. 1
O. S. Shifrin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Oleg S. Shifrin — Dr. Sci. (Med.), Professor; Chair of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology; Head, Department of Chronic Intestinal and Pancreatic Diseases, Vasilenko Clinic of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University).
119435, Moscow, Pogodinskaya str., 1, bld. 1
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Ivashkin V.T., Maev I.V., Andreev D.N., Goloshchapov O.V., Derinov A.A., Zolnikova O.Yu., Ivashkin K.V., Kiseleva O.Yu., Kiryukhin A.P., Lyashenko O.S., Poluektova E.A., Tertychnyy A.S., Trukhmanov A.S., Ulyanin A.I., Sheptulin A.A., Shifrin O.S. Modern Approaches to the Diagnosis and treatment of Clostridioides difficile (C. difficile)-associated Disease in Adults (literature Review and Expert Council Resolution). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2023;33(2):19-33. https://doi.org/10.22416/1382-4376-2023-33-2-19-33
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